Provider Demographics
NPI:1538472071
Name:INTEGRATIVE FAMILY DENTISTRY
Entity type:Organization
Organization Name:INTEGRATIVE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-304-3014
Mailing Address - Street 1:975 CAMERON LN
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9883
Mailing Address - Country:US
Mailing Address - Phone:919-304-3014
Mailing Address - Fax:919-304-3017
Practice Address - Street 1:975 CAMERON LN
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9883
Practice Address - Country:US
Practice Address - Phone:919-304-3014
Practice Address - Fax:919-304-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033367784OtherINDIVIDUAL NPI #
NC5910261 NCMedicaid